Asian Americans have been left out of health studies, but a U professor plans to change that

A nationwide study to determine the environmental factors that affect child development will include 780 pregnant Asian Americans from the Twin Cities, thanks to a $13.6 million grant from the National Institutes of Health (NIH).

The NIH grant represents a shift toward funding more inclusive research in environmental maternal health studies, after decades of failing to have enough Asian participants to match the composition of the U.S. population, according to University of Minnesota Prof. Ruby Nguyen, who won the grant.

The national study, called the Environmental Influences on Child Health Outcomes (ECHO) program, follows more than 100,000 children at research sites across the country. Nguyen's team is looking forward to enrolling participants next month.

"What we've been seeing across the board is that there's an underrepresentation of Asians in large national studies that are intended to represent multiple races and multiple people," Nguyen said.

Historically, a number of barriers — including language and a distrust of Western medicine— have kept Asian Americans from joining health studies. As a result, researchers have rarely included them in their grant requests.

"You'd see outcomes like rates of cancer or heart disease and not see an Asian category depicted," Nguyen said. "Asians make up six percent of the U.S. population. It's an incomplete story."

Nguyen's research focuses on reproductive health, including problems with conception and pregnancy such as birth defects, growth and development.

After studying at Johns Hopkins University in Baltimore and training in environmental health sciences at the NIH, Nguyen returned to Minnesota to serve the Asian communities where she was raised. She joined the faculty in the U's Division of Epidemiology and Community Health in 2007.

Her research team has examined the impact of phthalates, chemicals that are used by manufacturers to strengthen plastics and found in everyday products such as soaps and shampoos. Study results suggest that boys born to mothers with higher levels of the chemicals are more likely to exhibit genital abnormalities and language delays. The researchers also suspect those boys are likely to face neurodevelopmental, lung and reproductive issues.

Studies by other research teams have found high phthalate exposure in Hmong women in Green Bay, Wis., and more PFAS — the toxic so-called "forever chemicals" — in Asian American people. Phthalate exposure is more prevalent in low-income neighborhoods, where many Southeast Asian Minnesotans live.

Nguyen has connected with other researchers nationwide who seek to increase representation of Asian Americans in health studies. Collecting data is the first step toward identifying disparities, the researchers agree. Said Dr. Qi Zhao, the principal investigator at an ECHO site at the University of Tennessee: "We don't realize the health burden without the data."

One study that followed more than 900 South Asians in Chicago and the San Francisco Bay area found they developed risks associated with cardiovascular disease and diabetes at lower body weights than other racial and ethnic groups. In response, medical groups updated cholesterol guidelines to make it easier for South Asians to get medications such as statins.

A 2020 study co-authored by Dr. Rupa Basu, chief of the Air and Climate Epidemiology Section at the California Environmental Protection Agency, showed that Asians and other minority groups are at a higher risk for preterm delivery due to heat exposure and air pollution in the U.S. That could help doctors decide what precautions Asian people should take during pregnancy.

"When you know who's at high risk, or the doctor has information on who's at higher risk for adverse health outcomes, patients can get proper care," Basu said.

Still, progress is slow, and getting broad datasets including Asian Americans is still challenging, Basu said. The next step, she said, will be uncovering the reasons behind higher health risks in Asian communities.

Simply adding more study participants from a certain demographic group doesn't solve all the problems with health population studies. Often researchers lump Asians into a single category, which poses problems since health outcomes may differ by specific ethnicity and community.

"We have misleading conclusions when we only include one category of Asians," Nguyen said. "It feeds into the model minority myth, if we believe that all Asians have higher than average incomes and very few poor outcomes related to being Asian."

For example, Southeast Asian families in Minnesota face very different health concerns than families from India. Some of the top health concerns among Hmong people — substance abuse, mental health issues and domestic abuse — have often been overlooked, she said, while doctors focused physical health.

There has been a recent push to disaggregate data at both the state and national level. Minnesota Department of Health Commissioner Brooke Cunningham and White House officials have pledged to break down data into more specific categories, Nguyen said.

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